1962442608 NPI number — MS. BARBARA SHAW APN

Table of content: MS. BARBARA SHAW APN (NPI 1962442608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962442608 NPI number — MS. BARBARA SHAW APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
BARBARA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962442608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1128 N MOZART ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60622-2718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-235-7036
Provider Business Mailing Address Fax Number:
773-235-7036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 S DAMEN AVE
Provider Second Line Business Practice Location Address:
INTEGRATED HEALTH CARE, UIC COLLEGE OF NURSING, 9TH FL.
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-537-3950
Provider Business Practice Location Address Fax Number:
773-435-0119
Provider Enumeration Date:
06/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  209001421 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)